Early, Common, and Rare MS Symptoms

Multiple sclerosis (MS) is a progressive autoimmune disease that develops when the immune system attacks the myelin sheath (fatty coating of nerves) of nerves in the brain, spinal cord, and/or eyes. This is called demyelination and it affects the transmission of electrical impulses tied to movement, breathing, thinking, and more.

The damage can lead to a variety of symptoms including fatigue, muscle weakness, vision issues, and cognitive dysfunction. There are so many possible symptoms of MS that it's rare for two people with the disease to have the exact same ones. On top of that, in most cases, the symptoms of MS come and go (relapse and remit), and their severity can vary greatly.

Each person's specific symptoms depend on the location and extent of demyelination.

The First Signs of MS

Early symptoms of MS will vary from person to person, but people usually experience:

• Eye pain or blurred vision from inflammation of the optic nerve
• Numbness or tingling in the arms and legs due to spinal cord inflammation

Common Ongoing Symptoms of MS

While each case of MS is unique, a particular set of symptoms is common:

• Fatigue: Physical and mental exhaustion that isn't relieved by sleep or rest is the most debilitating aspect of MS for many people.
• Muscle-related symptoms: Impaired nerve communication can lead to weakness, tremor, and spasticity (involuntary tightness), which can eventually become bad enough to require the use of assistive devices such as a cane or wheelchair.
• Bowel and bladder symptoms: Frequent urination, urinary urgency or hesitancy, incontinence, constipation, and/or frequent urinary tract infections affect about 80% of people with MS.
• Cognitive dysfunction: Pervasive short-term memory problems, difficulty concentrating, word-finding issues, and sensory processing problems occur in about 50% of MS cases.
• Depression: The challenges of chronic illness combined with demyelination are both believed to contribute to mood problems, as can some common MS drugs, including Avonex/Rebif (interferon beta-1a) and Betaseron (interferon beta-1b).
• Sexual dysfunction: This can involve difficulty maintaining an erection, inability to orgasm, loss of desire, reduced or unpleasant sensations in the vagina, or vaginal dryness.
• Vision problems: These may be early symptoms and are due to optic neuritis (damage to the optic nerve). Symptoms can strike one or both eyes and include a dull ache, pain with eye movement, impaired or lost vision, loss of color vision, blind spots, and flashing or flickering lights.
• Vertigo: The sensation of spinning can result from MS-related damage to the brainstem (which connects the brain and spinal cord), a lesion in the cerebellum, or abnormal eye movement called nystagmus.
• Pain and other sensory symptoms: Electrical nerve zings, numbness and tingling, prickling, stabbing, tearing, or feelings of pressure can occur and be severe. Lhermitte's sign and the MS hug are two distinct MS pain symptoms.
  

Nerve pain, also called neuropathic pain, is hard to imagine if you've never felt it. It can be compared to hitting your funny bone or the pin-prick sensation of blood rushing back into a foot that's fallen asleep.

Rare Symptoms of MS

Some people with MS aren't aware that these uncommon symptoms are related to the disease:

• Trigeminal neuralgia (tic douloureux): Shock-like or burning pains in the face are due to damage to the fifth cranial nerve.
• Glossopharyngeal neuralgia: Pain in the tongue, throat, ear, or tonsils results from damage to the ninth cranial nerve.
• Paroxysmal symptoms: Momentary spasms in the limbs and sometimes in the muscles associated with speech or swallowing are sometimes mistaken for seizures.
• Pseudobulbar affect: Uncontrollable laughing or crying that's extreme or inappropriate to the situation may result from nerve damage in the cerebellum.
• Pruritus: This neurologically caused "itch" doesn't respond to scratching or topical treatments.
• Swallowing problems (dysphagia): Choking or coughing can happen while you eat or drink.
• Respiratory difficulties: Shallow breathing, shortness of breath, hiccups, cough, and frequent sighs may result from muscle weakness.
• Hearing loss: Temporary lessening or loss of hearing affects about 6% of people with MS; actual deafness is exceedingly rare.
• Seizures: These can affect between 2% and 5% of people with MS.

Frequency and Severity of MS Symptoms

The frequency and severity of symptoms depends to some degree on the form of MS you're diagnosed with. This includes four general types:

• Relapsing-remitting MS: Characterized by periods of experiencing symptoms (clinical attacks) and periods of remission
• Primary progressive MS: Symptoms constantly affect you and worsen over time
• Secondary progressive MS: May develop from relapsing-remitting MS; there are no periods of remission and you become more disabled
• Progressive relapsing MS: Rare form that starts similar to primary progressive MS but clinical attacks occur and symptoms are more severe
  

Complications

Some possible complications of MS include:

• Aspiration pneumonia: A lung infection caused by inhaling food particles due to dysphagia or difficulties swallowing
• Malnutrition and dehydration: A result of dysphagia that makes eating difficult
• Pressure sores: Due to lack of mobility
• Venous thromboembolism: Blood clots blocking blood vessels, possibly due to lack of mobility, spasticity, or a steroid-medication side effect

Not everyone will experience these. And like MS symptoms, complications can vary greatly in those who do.

When to See a Healthcare Provider

If you have symptoms that could indicate MS, and especially if they come and go, be sure to talk to your healthcare provider about it. Early MS diagnosis and treatment have long-term benefits, so don't hesitate or wait to bring up what you're experiencing.

After your diagnosis, it's important to let your healthcare provider know about any changes or new symptoms you experience. It's typical for MS symptoms to get better or completely go away for a time, and then come back with new or worse symptoms.

Remember that just because MS can cause something doesn't mean it's always the cause. You don't want to dismiss something as "just another MS symptom" only to have it be something else that needs prompt diagnosis and treatment.

A Word From Verywell

Looking over these lists can be overwhelming. Keep in mind that you probably won't experience most of the potential symptoms. And while there's no cure for MS, there are ways to manage the disease and its symptoms.

Disease modifying therapies are drugs that slow the progression of MS and lower the risk of relapse. These, plus other medications and lifestyle changes, can help improve your symptoms and quality of life.